TY - JOUR
T1 - Unrelated donor bone marrow transplantation for children with acute leukemia
AU - Davies, S. M.
AU - Wagner, John E
AU - Shu, X. O.
AU - Blazar, Bruce R
AU - Katsanis, E.
AU - Orchard, Paul J
AU - Kersey, J. H.
AU - Dusenbery, Kathryn E
AU - Weisdorf, Daniel J
AU - Mc Glave, Philip B
AU - Ramsay, N. K.
PY - 1997/2
Y1 - 1997/2
N2 - Purpose: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. Patients and Methods: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched at HLA-A,B and DRB1;20 (40%) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. Results: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39%) in matched and 32% (95% CI, 8% to 52%) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37% (95% CI, 21% to 53%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients with AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. Conclusion: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.
AB - Purpose: To test the use of unrelated donor bone marrow transplantation (URD BMT) to cure children with high-risk acute leukemias. Patients and Methods: Between June 1985 and December 1994, 50 children with acute leukemia (15 acute myelogenous leukemia [AML], 35 acute lymphoblastic leukemia [ALL]; 22 greater than second complete remission [CR]) received BMT from a URD at the University of Minnesota. Ages ranged from 0.9 to 17.5 years (median, 8.8). Median follow-up is 2.1 years (range, 1 to 7.3). Thirty patients (60%) received bone marrow fully matched at HLA-A,B and DRB1;20 (40%) received bone marrow with a major or minor mismatch at a single HLA-A or B locus. Results: The median time to neutrophil engraftment was day 24 (range, 14 to 42 days) in those receiving matched and day 25 (range, 15 to 32 days) in those receiving mismatched marrow (P = .35). The incidence of grades III to IV graft-versus-host disease (GVHD) was 23% (95% confidence interval [CI], 7% to 39%) in matched and 32% (95% CI, 8% to 52%) in HLA-mismatched patients (P = .57). The incidence of chronic GVHD was 50% (95% CI, 28% to 72%) in matched and 57% (95% CI, 23% to 91%) in mismatched patients (P = .80). Disease-free survival for patients with ALL is 37% (95% CI, 21% to 53%) at 1 year and 30% (95% CI, 15% to 46%) at 2 years; for patients with AML, 53% (95% CI, 28% to 78%) at 1 year and 33% (95% CI, 6% to 60%) at 2 years. Conclusion: URD BMT is an effective treatment for children with poor-prognosis acute leukemia and should be considered for all high-risk patients. Early referral of patients is strongly recommended.
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U2 - 10.1200/JCO.1997.15.2.557
DO - 10.1200/JCO.1997.15.2.557
M3 - Article
C2 - 9053477
AN - SCOPUS:18844464929
SN - 0732-183X
VL - 15
SP - 557
EP - 565
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 2
ER -